Barbara Hogan: South Africa's Minister of Health

Abstract

Rarely has a South African Cabinet reshuffle been greeted with such enthusiasm and expectation as the appointment last September of Barbara Hogan to Minister of Health, when she took over from her discredited predecessor Manto Tshabalala-Msimang. Hogan has faced a baptism of fire, having to confront the spread of cholera from Zimbabwe over the South African border, which has added to the already daunting challenges facing the country's health system. Many think she has passed the 100-day test with flying colours. “She is absolutely superb. She hasn't put a foot wrong”, says Francois Venter, head of the Southern African AIDS Clinicians Society. He adds that there is now a palpable sense of optimism among health workers.Hogan has helped to foster this optimism. At a conference on the quality of health care in November, she related an anecdote about three men on a building site. When asked, the first worker grumbled that he was busy chipping away at rocks; the second sighed that he was earning a living; the third smiled and said “I am building a cathedral!” According to Hogan, “To effect a shift to the ‘new’, our health-care system needs people that are willing to build a cathedral…with a smile on their face!” She also recognises the key role of health workers in this project: “The health service is also about health-care workers who work under very difficult conditions. They also expect significant improvement in their working conditions.”As one of the few ranking African National Congress (ANC) MPs to side with AIDS activists in their long-running battle to force the South African Government to provide antiretroviral medicines, Hogan won the respect of many health workers. “She gave us hope when it was dark”, says Treatment Action Campaign founder Zackie Achmat. On becoming minister, Hogan was quick to declare “We know that HIV causes AIDS” and said she would give top priority to tackling the dual HIV/tuberculosis emergency and rolling out programmes for the prevention of mother-to-child transmission. Malegapuru Makgoba, vice chancellor and principal of the University of KwaZulu-Natal, says that for the first time in years, South African academics were free to “state that HIV causes AIDS without getting threats”.Access to antiretrovirals and tuberculosis treatment is a critical issue Hogan told The Lancet: “We have millions of people living with HIV in South Africa and thousands who require access to treatment, care, and support including persons coming from other parts of southern Africa who are seeking health services for TB and HIV here. While we have hundreds of thousands of people on ARV treatment in South Africa, this number must be increased.”Hogan says the ANC chose her as minister because of her finance and management skills, backed up by Molefi Sefularo, a physician and respected former provincial health leader as her deputy. She swiftly named as special adviser Fatima Hassan, an advocate with the AIDS Law Project who was involved in litigation to force Mbeki's Government to roll out antiretroviral treatment. Hogan says it will take about 5 years to turn around the Health Ministry, which has been plagued by mismanagement, and to improve the quality of health care. But she is not daunted by the challenges: “We have many, many very skilled people in the health sector, and in civil society, and it has been encouraging to experience the huge wave of goodwill and enthusiasm to put things right. We obviously will not be able to change things overnight but with a steady focus on strategic priorities and a systematic resolution of problems we will make good progress. It will be difficult at times, but we have a mission to improve the lives of South Africans and those in our bordering countries and this will keep our focus”, she told The Lancet.As cholera, which has killed more than 2100 people in Zimbabwe, spread into South Africa, Hogan looked aghast when asked if her Government would turn back illegal immigrants with the disease. “We cannot look upon people who are suffering enormously in Zimbabwe and look down on them and say these are illegals”, she said. “These are people who need our help. They are our neighbours.” Her impassioned remarks about the plight of Zimbabweans—the Government is usually cautious in its declarations—prompted one of Robert Mugabe's closest advisers to misidentify her as the UK's Minister of Health in a vitriolic newspaper editorial.Hogan's passionate attitude reflects her own personal history. She earned a degree in development studies from Wits University, where she also became active in the then banned ANC and helped organise consumer boycotts. In 1981, she was arrested and became the first white South African woman to be charged with high treason and was sentenced to 10 years in prison—during which time she enrolled for economics and accounting studies. Hogan has spoken publicly about the constant interrogation and torture she endured during her imprisonment. She was only released a month after the ANC was legalised in 1990.Although it is unclear whether ANC leader Jacob Zuma, who is expected to become President in the forthcoming elections, will retain Hogan, she has already made a clean break from the past, emphasising compassion and compromise. “She inherited hell with no money and she is already making a difference”, says Venter. Rarely has a South African Cabinet reshuffle been greeted with such enthusiasm and expectation as the appointment last September of Barbara Hogan to Minister of Health, when she took over from her discredited predecessor Manto Tshabalala-Msimang. Hogan has faced a baptism of fire, having to confront the spread of cholera from Zimbabwe over the South African border, which has added to the already daunting challenges facing the country's health system. Many think she has passed the 100-day test with flying colours. “She is absolutely superb. She hasn't put a foot wrong”, says Francois Venter, head of the Southern African AIDS Clinicians Society. He adds that there is now a palpable sense of optimism among health workers. Hogan has helped to foster this optimism. At a conference on the quality of health care in November, she related an anecdote about three men on a building site. When asked, the first worker grumbled that he was busy chipping away at rocks; the second sighed that he was earning a living; the third smiled and said “I am building a cathedral!” According to Hogan, “To effect a shift to the ‘new’, our health-care system needs people that are willing to build a cathedral…with a smile on their face!” She also recognises the key role of health workers in this project: “The health service is also about health-care workers who work under very difficult conditions. They also expect significant improvement in their working conditions.” As one of the few ranking African National Congress (ANC) MPs to side with AIDS activists in their long-running battle to force the South African Government to provide antiretroviral medicines, Hogan won the respect of many health workers. “She gave us hope when it was dark”, says Treatment Action Campaign founder Zackie Achmat. On becoming minister, Hogan was quick to declare “We know that HIV causes AIDS” and said she would give top priority to tackling the dual HIV/tuberculosis emergency and rolling out programmes for the prevention of mother-to-child transmission. Malegapuru Makgoba, vice chancellor and principal of the University of KwaZulu-Natal, says that for the first time in years, South African academics were free to “state that HIV causes AIDS without getting threats”. Access to antiretrovirals and tuberculosis treatment is a critical issue Hogan told The Lancet: “We have millions of people living with HIV in South Africa and thousands who require access to treatment, care, and support including persons coming from other parts of southern Africa who are seeking health services for TB and HIV here. While we have hundreds of thousands of people on ARV treatment in South Africa, this number must be increased.” Hogan says the ANC chose her as minister because of her finance and management skills, backed up by Molefi Sefularo, a physician and respected former provincial health leader as her deputy. She swiftly named as special adviser Fatima Hassan, an advocate with the AIDS Law Project who was involved in litigation to force Mbeki's Government to roll out antiretroviral treatment. Hogan says it will take about 5 years to turn around the Health Ministry, which has been plagued by mismanagement, and to improve the quality of health care. But she is not daunted by the challenges: “We have many, many very skilled people in the health sector, and in civil society, and it has been encouraging to experience the huge wave of goodwill and enthusiasm to put things right. We obviously will not be able to change things overnight but with a steady focus on strategic priorities and a systematic resolution of problems we will make good progress. It will be difficult at times, but we have a mission to improve the lives of South Africans and those in our bordering countries and this will keep our focus”, she told The Lancet. As cholera, which has killed more than 2100 people in Zimbabwe, spread into South Africa, Hogan looked aghast when asked if her Government would turn back illegal immigrants with the disease. “We cannot look upon people who are suffering enormously in Zimbabwe and look down on them and say these are illegals”, she said. “These are people who need our help. They are our neighbours.” Her impassioned remarks about the plight of Zimbabweans—the Government is usually cautious in its declarations—prompted one of Robert Mugabe's closest advisers to misidentify her as the UK's Minister of Health in a vitriolic newspaper editorial. Hogan's passionate attitude reflects her own personal history. She earned a degree in development studies from Wits University, where she also became active in the then banned ANC and helped organise consumer boycotts. In 1981, she was arrested and became the first white South African woman to be charged with high treason and was sentenced to 10 years in prison—during which time she enrolled for economics and accounting studies. Hogan has spoken publicly about the constant interrogation and torture she endured during her imprisonment. She was only released a month after the ANC was legalised in 1990. Although it is unclear whether ANC leader Jacob Zuma, who is expected to become President in the forthcoming elections, will retain Hogan, she has already made a clean break from the past, emphasising compassion and compromise. “She inherited hell with no money and she is already making a difference”, says Venter. South Africa heads into elections in a sorry state of healthSouth Africa's ruling African National Congress has singled out health as one of the top five priorities for the next government. With good reason. Clare Kapp reports from Cape Town. Full-Text PDF